Bassem NASR1*, Malek BARKA2, Waad FARHAT2, BEN LTAIFA Afef2, Abdelkader MIZOUNI2, Mohammed Said NAKHLI3, Mohammed BEN MABROUK2 and Ali BEN ALI2
1Specialist in General and Digestive Surgery, Parietal Surgery – Proctology, Tunisia
2Department of Surgery University Hospital of Sahloul, Sousse Tunisia
3Department of Anesthesia and Reanimation University Hospital of Sahloul Sousse, Tunisia
*Corresponding Author: Specialist in General and Digestive Surgery, Parietal Surgery – Proctology, Tunisia
Received: November 22, 2019; Published: January 08, 2020
Introduction: Acute Necrotizing pancreatitis (ANP) represents the severe form of human acute pancreatitis (15% of cases). Infection of pancreatic necrosis occurs in 40– 70% of patients with ANP and have mortality rate about 80% of cases. Therefore, early diagnosis of infection in ANP is extremely important. We aimed to describe the diagnostic criteria(clinical, biological and radiological data) and the different modalities of treatment of this complication (medical, percutaneous drainage or surgery).
Methods: One hundred and nineteen patients with ANP were enrolled, among them, 50 (42%) were found to have pancreatic infection. Demographic and clinical characteristics, laboratory examination results, complications and treatment modalities of these patients were collected from their medical records.
Results: Infection of pancreatic necrosis was observed in 42% of cases. Positive diagnosis of infection is kept to a set of clinical data, which are fever (95.9%), signs of peritoneal irritation (81.6%); Biological which are elevation of CRP rate (98%) and white blood cells (93.9%); positive blood cultures (18%) and radiological which are collections with peripheral enhancement (98%); peri-pancreatic air bubbles (18.8%). The treatment was based on an antibiotic therapy alone in 16 patients, and associated with collection drainage in the remaining cases. The drainage was percutaneous in 12 patients with a success rate of 16.66%. The need for surgical necrosectomy was required in 32 patients. The necrosectomy was associated in 15 cases with a gesture of the biliary tract (cholecystectomy with or without external biliary drainage). Bacteriological examination found a predominance of BGN and anaerobes. The mortality rate was high at 42%.
Conclusion: Infection of pancreatic necrosis is a serious complication of ANP. Its diagnosis is based on a set of clinical, biological and imaging data. The treatment is, essentially, medical based in an adequate antibiotic therapy witch can be associated with percutaneous drainage or surgery. This complication has a high rate of mortality.
Keywords: Acute Pancreatitis; Infection; Treatment; Prognostic
Citation: Bassem NASR., eet al. “Diagnosis and Management of Pancreatic Necrosis Infection”. Acta Scientific Gastrointestinal Disorders 4.2 (2020): 09-16.
Copyright: © 2020 Bassem NASR., eet al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.